The recent work by Curovic et al. (1) highlights the need to individualize novel therapies in heterogeneous conditions such as diabetic kidney disease. However, the trial design used by the authors has serious methodological flaws that threaten the validity of the comparisons made between alternative treatments. In their article, the authors examine the albuminuria-lowering performance of four drug classes in the first four periods of a randomized crossover trial. Each individual is then reexposed to the drug class with the greatest response (the “winner”) in a confirmatory period; the trial’s primary outcome is the difference between the response in this confirmatory period and the mean response of the three “losers” from the first four periods of the trial.
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